Inspection on 10/11/05 for Barn and Coach House

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Barn and Coach House 03/01/08

Barn and Coach House 06/03/07

Barn and Coach House 12/05/06

Barn and Coach House 30/06/05

Barn and Coach House 21/01/05

Barn and Coach House 26/07/04

Barn and Coach House 27/01/04

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Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Barn and Coach House Barn & Coach House High Road North Stifford Essex RM16 5UE Lead Inspector Jacqueline Graves Unannounced Inspection 10th November, 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Barn and Coach House Address Barn & Coach House High Road North Stifford Essex RM16 5UE 01375 383543 01375 387715 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Susan Carol Merchant Ms Sharon Maureen Venton Care Home 15 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (15) of places Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home provides accommodation and personal care for up to 15 Older People over the age of 65 years. The home provides accommodation and personal care for up to 6 service users with dementia over the age of 65 years. 30th June 2005 Date of last inspection Brief Description of the Service: The Barn and Coach House Residential Home provides care and accommodation for fifteen older people. It has eleven single bedrooms and two shared rooms. Each bedroom has a call bell facility and T.V. point. The home has a stair lift, which provides access to the first floor, for people who are not able to climb the stairs. The home has a large garden to the front of the property and some car parking space. The home is privately owned. It is situated at the end of the village of North Stifford and is close to Lakeside Shopping Centre and Grays Town. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection that took place over five and a half hours. The inspector toured the premises, including some residents’ rooms, spoke to some residents, the manager and staff and looked at some records. What the service does well: What has improved since the last inspection? What they could do better: There has been a poor response to requirements and recommendations made previously. The registered person has been asked at past inspections to visit the home, to monitor the care, write reports of these visits and give them to the manager and CSCI. This has not been done. An immediate requirement notice was served in relation to this and to require the home to have care plans for all residents, carry out thorough recruitment checks on new staff and ensure staff supervision, including the manager, takes place on a regular basis. Staff would like to be able to organise more outings for residents outside of the home and extend the resources they have available for activities within the home. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4,5 Following current good practice on helping people with dementia ,find their way around the home, would make the home more suitable for them. EVIDENCE: Some staff and residents spoken to said prospective residents and their families are able to visit the home before making a decision to move in. There are some adaptations in the home to make it suitable for the elderly, such as a stair lift and some large print signs. There are handrails in places but no handrails in the corridor to assist people. The decoration of the home is not particularly geared to those people who have dementia. The inspector found the paper towel dispensers in bathrooms very difficult to use as the opening for the paper towels was so small. Staff agreed that they were difficult for residents to use. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 Resident’s needs would be better met if staff could work from plans for their care and health. EVIDENCE: The inspector looked at two residents’ files. Daily recordings to show how the people had been and what they had done were clear. One file did not contain a photo of the resident. There was no care plan available for one resident; the manager thought it might have been misplaced. At the previous inspection, another resident didn’t have a care plan so on this visit an immediate requirement notice was left asking the registered person to ensure that all residents have care plans. There was a record of visits by health professionals which showed that the home is active in seeking help and advice on resident’s behalf, with visits by a continence advisor, G.P., chiropodist and district nurse. A plan for healthcare wasn’t seen, as the whole care plan was not available. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 10 One file recorded that a resident needed to be moved by use of a hoist. A risk assessment on moving this resident was out of date and their weight had not been recorded to calculate the appropriate way of moving them. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Opportunities for residents to mix with people outside the home are slowly developing. Further resources for activities within the home would improve how people are occupied. EVIDENCE: Staff worked with residents to keep them occupied by talking to them, painting ladies’ nails and playing some games. A weekly plan of activities included memory exercise, singsongs and armchair exercise. An entertainer visits each month. Representatives from a local church visit the home to hold services and talk to the residents. One resident said that staff take them to church occasionally. Those residents spoken to said they have enough to do and mostly like to read or watch T.V. Staff try to organise activities for special occasions and had organised a firework party on November 5th, for residents and their relatives. An indication of their dedication to their work is that some staff assist with such activities in their own time. Staff mentioned that they would like an activities budget so they could buy more resources, such as large print cards and games, for the residents. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 12 Residents spoken to said they get plenty to eat and drink and the food is fine. One resident said they would like a cooked breakfast some mornings. The cook confirmed that this would be possible and is often provided at the request of residents. Fresh fruit and vegetables are included in menus. Menus are adjusted if residents do not like certain meals and the cook had a good understanding of the likes/dislikes and special dietary needs of residents. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home has taken steps to protect vulnerable adults. EVIDENCE: The home has a policy on protecting vulnerable adults which is accessible to staff. A record of training showed that four staff recently attended training on the protection of vulnerable adults. The manager advised that further staff are to be trained. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,25,26 Staff training on infection control has been provided but will be ineffective if systems in the home do not encourage good hygiene. EVIDENCE: Those residents spoken to said they were pleased with their rooms. Those rooms seen were pleasantly decorated and some had been made homely with people’s own belongings and furnishings. Some areas of a corridor were in need of redecoration and this had been planned. Some rooms seen did not have all the minimum furnishings, such as bedside lighting and a comfortable chair. This may well be the residents’ choice but it needs to be shown that people have been offered these by writing it on their care plans. Lights in a resident’s room and a communal bathroom were not working. The premises were clean and there were no unpleasant odours. There are still no hand washing facilities for staff in the laundry room. This, and the fact that Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 15 the home does not have sluice facilities, presents an increased risk of cross infection when staff have to clean bedpans in bathrooms and handle soiled linen in the laundry room. Plastic gloves were not available which presents as poor hygiene; staff advised that these were on order. The garden was in need of maintenance. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The staff were caring and kind towards the residents. As the home has not been able to evidence a robust recruitment process at this and the previous inspection, an immediate requirement notice was left. This asks the registered person to attend to this matter urgently and to tell CSCI what they plan to do to achieve minimum standards. EVIDENCE: Residents said the staff looked after them very well and were very nice people. The inspector was advised that two vacancies for care staff had been advertised, with a good response. The manager advised that existing staff are covering the vacancies but agency staff would be employed to cover emergencies if necessary. Staff opinions, on whether there were sufficient staff at all times, varied. Some staff felt that they were stretched at busy times ,such as at lunch ,whilst others felt they managed to meet residents’ needs. Training on infection control, Parkinson’s disease, the protection of vulnerable adults and reminiscing has been provided for some staff this year. Training on food hygiene is due for all care staff. The manager confirmed that all staff have at least three days paid training per year. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 17 The manager advised that six members of staff are working to achieve NVQ 2 which is a considerable number for a small home. Two staff files were looked at. Each contained two references but two were addressed ‘to whom it may concern’. One had an incomplete induction checklist. Neither had a record of interview or a CRB check. The manager advised that the proprietor might have CRB checks and that if so, these could be shown to CSCI at a later date. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35,36,38 As the home has not been able to evidence supervision of staff or visits by the registered person ,under regulation 26, at this and the previous inspection, an immediate requirement notice was left. This asks the registered person to attend to these matters urgently and to tell CSCI what they plan to do to achieve minimum standards. EVIDENCE: Those staff supervision records seen were recorded on staff appraisal forms. Formal supervision is not taking place regularly but the manager feels that staff are informally supervised in the home. The manager does not receive supervision. Those people identified as supervisors need training on how to supervise staff. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 19 The kitchen was clean and tidy. The home reported a satisfactory recent visit from environmental health. In the fridge there was a tin of evaporated milk which had passed the expiry date and some opened food which had been covered but not dated. Staff reported that they did not feel respected by the registered proprietor. This is an issue that has been raised previously. The manager advised that water temperatures are recorded weekly to ensure water is delivered at safe temperatures and that monitoring to prevent Legionella does not apply to this home because of sealed units. Fire equipment had been checked. A certificate of gas safety was seen but not one of gas maintenance. The home had a current certificate of employer’s liability insurance. Staff bags and coats were on chairs in the dining room so confused residents could possibly find lighters, medicines, etc. in bags. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 2 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X 2 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 1 X X 1 X 2 Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP5 Regulation 23(2)(n) Requirement That sufficient handrails are provided and paper towel dispensers are suitable for use by elderly / infirm people. Ensure that all residents have care plans, including health, so staff have clear instructions on how to care for them (as in Sch.1(b) ). Previous timescale of 15/7/05 not met A photo of each resident must be available. (as in Sch.3 (2) ) Have up to date risk assessments for moving and handling people, including people’s weight. Facilitate local/community activities, for example shopping, should this be required by residents. Partly met. Previous timescale 1/9/05 Ensure the premises are kept in a good state of repair. This relates to lights that need repair. Partly met. Previous timescale 1/8/05 Ensure rooms have sufficient lighting. Previous timescale of 12/7/05 not met DS0000018117.V268041.R01.S.doc Timescale for action 01/05/06 2 OP7 15(1) 01/12/05 3 OP8 13(4)(C)( 5) 16(2)(m) 01/01/06 4 OP12 01/02/06 5 OP19 23(2)(b)( d) 01/03/06 6 OP25 13(3) 01/01/06 Barn and Coach House Version 5.0 Page 22 7 OP26 16(2)13(3 ) 8 9 OP29 OP32 10 OP33 11 OP36 12 OP38 Provide a means of hand washing and drying in the laundry. Residents toiletries must not be stored communally. Previous timescale of 1/8/05 not met 19(1)(a)( Carry out all required b)Sch.2 recruitment checks. Previous timescale of 15/7/05 not met 12(5)(a) The registered provider should maintain good personal and professional relationships with staff. Previous timescale of 4/3/05 not met 23(4)(e) The registered provider, or their representative, must visit the home in line with this regulation and must supply a copy of the of the report of the visit to CSCI and the home. Previous timescales of 4/3/05 and 26/7/04 not met 18 The registered person must ensure that formal supervision, including the manager, takes place on a regular basis Previous timescale of 4/3/05 not met 23(1a)(4) Provide a certificate of gas (e)23(2m) maintenance (copy to CSCI) and evidence regular fire drills. Previous timescale of 1/8/05 not met Provide secure storage for staff belongings. 01/01/06 01/03/06 01/02/06 01/12/06 01/12/05 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP5 Good Practice Recommendations That as the home is maintained and redecorated, DS0000018117.V268041.R01.S.doc Version 5.0 Page 23 Barn and Coach House 2 3 4 5 6 7 8 9 OP9 OP24 OP26 OP27 OP28 OP30 OP36 OP38 consideration is given to current good practice regarding helping people with dementia find their way around the building and identify their own rooms. That phots of residents are on medication records to assist identification. Not inspected Provide bedside lighting in the absence of residents own provision. The home should have a sluice facility that is separate from the laundry. Check that there are sufficient staff at peak times of activity throughout the day and supply additional staff if required. A minimum of 50 staff obtain NVQ Level 2 by 2005. All staff should attend food hygiene training. That formal staff supervision takes place at least six times a year. That supervisors are trained in supervision. That food is discarded after the use by date and opened food is dated. Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Barn and Coach House DS0000018117.V268041.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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